What a year!!!

As I reflect on 2011, from a health policy perspective, it has been quite a year indeed. Berwick is out, ACOs are in, and costs continue to rise. Employers are trying everything and corporate wellness and prevention is the "new green". The lines separating payers, providers and purchasers are blurring every single day as insurance companies buy doctor practices and hospitals too!! The New England Journal says Disease Management doesn't work and everyone believes one study based on the sickest Medicare patients only. It is increasingly difficult to separate out the "truth" from the background noise, especially as the noise gets louder and louder.

Personally, I am really looking forward to 2012 and the ongoing struggle to make health care more accountable, transparent, safer and more cost effective. I am confident that the Jefferson School of Population Health will continue to provide leadership in its research, teaching and dissemination agenda. Our journals, this BLOG, our Medpages column, our national conferences, continue to resonate with the key opinion leaders in healthcare across the nation.

I hope that you will continue to turn to us for informed opinions and solid evidence too about what is working and what is not. One thing surely still remains the same regarding the reform efforts and that is of course " No Outcome--No Income". I am convinced that the future belongs to groups that can make this pithy statement a reality for everyday practice. We are always interested in your views too. DAVID NASH

More on Accountable Care Organizations

The Jefferson School of Population Health just finished hosting a special two day invitation only advisory board on the current status of Health Reform. We had one dozen experts from all around the nation convene on our campus for a two day discussion of the details and an update on implementation challenges. It was sobering indeed!! At this juncture, I believe that most organizations are NOT culturally ready for the hard work of true accountability.The heart of a real ACO, whether with Medicare or commercial patients, is the realization that clinicians will have to self evaluate, measure what they do everyday, and be willing to engage in the gut bustingly difficult work of improvement. The "shared savings" may in fact be minimal, especially in the early stages. It will take a commitment to practicing based on the evidence and a willingness to benchmark performance against regional and national leaders. A tall order for any organization and in my view, most are not at all ready for this cultural paradigm shift. Who will make it---organizations with a hierarchical doctor culure, accustomed to profiling and willing to police members within their own ranks. The Ochsners, Geisingers and Mayos of the world will be able to make it work, very few others have the skill sets necessary at this juncture. Stay tuned for more posts from our amazing advisory board and for publications that will come from our deliberations together. DAVID NASH